An investigation
found food safety problems at nursing homes
nationwide.
Oct. 3, 2019, 2:30 AM CDT By Marjie Lundstrom,
FairWarning
This
article was produced by FairWarning, a nonprofit news organization
based in Southern California that focuses on public health, consumer and
environmental issues.
Flies
buzzing the undercooked hamburgers. Cockroaches scurrying for cover behind the
oven. A moldy ice machine. Mystery debris, clinging to the crevices of a meat
slicer. Hundreds of mouse droppings, trailing across the hood of the stove.
These
incidents are not logged in any restaurant inspector’s notebook. They are among
the thousands of food safety violations discovered in the last three years in
America’s nursing homes, where fragile residents can least tolerate such
lapses.
While
allegations of elder abuse and neglect dominate the horror stories in long-term
care settings — bedsores, falls, medication errors, sexual assaults — food
handling remains a consistent and often overlooked hazard, FairWarning found in
a five-month investigation.
“There’s
huge underreporting of food issues,” said Charlene
Harrington, a nurse and professor at the University of California,
San Francisco, who has researched nursing home quality.
“It’s
an accepted practice to have crappy conditions in the kitchen,” she said. “And
people are just totally unaware of it.”
As
America’s population ages, hundreds of thousands of baby boomers have found
their way into nursing homes, assisted living communities and memory care
units. With this wave of seniors has come new dining demands, a culinary call
that has been answered in some places with gourmet chefs, a panoply of fresh
fruits and vegetables and other healthy flourishes.
But
dangerous and unhealthy conditions persist.
FairWarning’s
investigation, based on inspection reports, federal data and interviews with
residents and long-term care experts, found that residents nationwide are at
risk for foodborne illness from unsafe kitchens.
Across
the country, 230 foodborne illness outbreaks were
reported from 1998 to 2017 in long-term care settings, according to the Centers
for Disease Control and Prevention. The outbreaks resulted in 54 deaths and 532
hospitalizations, and sickened 7,648 people.:16
Not all
foodborne illnesses in long-term care are directly caused by poor sanitation;
some outbreaks result from contaminated food brought in from the outside.
But
critical internal mistakes have happened. Last year, 29 residents and 32 staff
members at the Pine View Care Center in Black River Falls, Wisconsin, were
sickened in a norovirus outbreak, according to the government’s inspection report. Investigators found that
kitchen staff had repeatedly failed to check the sanitizer levels in the
dishwasher and didn’t know the injector was clogged, the report said. The
facility’s administrator did not return phone calls or email for comment.
While
foodborne illness is a threat to any age group, people over 65 are especially susceptible due
to weakened immune systems, chronic diseases, immobility and age-related
changes in their digestive systems.
Yet
unlike restaurant patrons, who can walk away from bad meals — and trash the
establishment later on Yelp — long-term care residents are basically stuck.
Unsafe
food handling was the third most frequently cited violation last
year inside America’s estimated 15,700 nursing homes, behind only infection
control and accidents, according to data from the Centers for Medicare &
Medicaid Services, which regulates nursing homes that receive federal money.
These figures do not include assisted living communities, which have no
nationwide centralized data collection and are licensed by the states, which
create their own standards.
In
2018, 33 percent of nursing homes were
cited for violating the federal requirement to safely store, prepare and serve
food.
Several
of the largest nursing home chains had even worse track records, federal data
show.
Genesis
HealthCare, the nation’s largest for-profit chain with some 400 facilities in
27 states, saw more than 43 percent of its nursing homes cited for
food safety lapses last year. “We are aware of some regulatory compliance
issues and are working diligently to resolve any problems as quickly as possible,”
Genesis spokeswoman Lori Mayer said in an email.
Dr.
David Gifford, a senior vice president and chief medical officer of the trade
group for long-term care providers, defended the industry’s handling of food
safety in an email to FairWarning.
“Because
long-term care providers take many steps to prevent outbreaks of foodborne
illness, such outbreaks are rare,” said Gifford of the American
Health Care Association, which represents more than 13,500 nonproft
and for-profit facilities for the elderly and disabled.
“The
vast majority of issues identified during inspections are important to correct
but are rated by the state and federal officials as unlikely to put anyone’s
health at significant risk.” Examples of less critical offenses that can result
in citations, he wrote, include things like staff members failing to wear
gloves, a bearded worker without a face guard or unlabeled leftovers.
The
true extent of foodborne illnesses and deaths in long-term care is unknown,
since the CDC data is almost certainly an undercount.
A CDC
spokesman said the agency relies on the voluntary reporting of foodborne
illness outbreaks by state, local and territorial public
health departments, and that some of these agencies have
limited resources and training. Another “major limitation” in the data
collection is that many illnesses go unreported because the
sick individuals never seek medical care and get diagnosed, he said.
And
federal safeguards for this vulnerable population may be eroding.
In
July, the Trump administration moved to roll back a series of protections for
nursing home residents, including one proposal that would lower the
qualifications for directors of food and nutrition services. The government
contends that the changes would eliminate requirements that are “unnecessary,
obsolete or excessively burdensome.”
“They’re
clearly weakening the standards regarding food service and the safety of food
handling,” said Richard Mollot, executive director of the New York-based Long Term
Care Community Coalition, a nonprofit focused on improving care in
nursing homes and other residential settings.
Gifford,
of the trade association, argues that the changes would address “workforce
concerns, particularly in rural areas,” by allowing facilities to retain “qualified”
staff who have worked there for years.
Long-term
care advocates blame many food safety problems on operators who are so intent
on increasing profits that they routinely skimp on residents’ dietary needs, or
slash kitchen staff.
Some
nursing homes violate the same food safety rule again and again. Since January
2016, about a third of all nursing homes were cited two or more times for the
same food safety violation, according to a FairWarning analysis of federal
data.
Gifford
noted that repeat citations may result from the array of issues that fall under
the same food safety regulation.
FairWarning’s
analysis found that one Arkansas nursing home was written up seven times in the
last three years, receiving a single fine of less than $8,000. Violations at The Waters of North Little Rock, previously
known as the North Little Rock Health and Rehabilitation Center, included
unsealed foods in storage, grimy kitchen appliances and staff with unwashed
hands touching residents’ food, inspection reports show.
When
the nursing home was cited a sixth time in July 2018, a government inspector
asked the director of nursing if she would eat the food prepared in the
kitchen.
“No,”
the nurse responded, according to the inspection report.
The
140-bed facility changed ownership early this year,
public documents show, and its current administrator, Spencer Rogers, told
FairWarning the food safety problems have been corrected, although the home
was cited again in April for unwashed hands,
expired food and dirty equipment. The home previously was owned by New
Jersey-based Skyline Health Care, a chain that recently collapsed, leaving a multistate trail
of nursing home closures, dislocated residents and damning inspection reports.
Food
safety experts fear that problems may be worse in assisted living centers,
which lack federal oversight.
“I’ve
seen horrible stuff — bugs crawling in food, rodents actually in the pantries —
it’s just horrific, especially when you get into some of these smaller assisted
living facilities that are just barely keeping it together,” said Brian Lee,
executive director of Families for Better Care, a
Texas-based nonprofit that advocates for residents in long-term care.
Audrey
Kelly of Los Angeles said she quickly moved her 98-year-old mother out of a
six-person assisted living facility this year after a caregiver reported
finding a cockroach in the kitchen and a complaint was filed with the California
Department of Social Services. “It’s not right,” Kelly said. “It was really, really
disgusting.”
She
said her mother, Sally Kelly, who uses a wheelchair after several strokes,
became ill several times during her stay at the Toluca Lake Manor Senior
Assisted Living home in Sherman Oaks, California, suffering from severe stomach
cramps and diarrhea, though the cause of the symptoms is unclear.
The
state, which did not find roaches in a follow-up visit, substantiated Kelly’s complaint anyway
and cited the home. The home’s administrator, Mariana Romano, told FairWarning
she promptly reported Kelly’s complaint to state officials and brought in two
extermination companies. She denied to state officials that she had any pest
problems. “You can say anything,” Romano said. “It doesn’t mean it’s true.”
One
Georgia woman, who lives in an assisted living facility near Atlanta where
rooms cost thousands of dollars a month, said she has experienced several bouts
of food-related illness that confined her to bed. Residents recently were upset
by moldy cheese and wilted lettuce that appeared on the salad bar.
“It was
just horrible,” said the woman, who asked not to be identified for fear of
reprisal.
Some
states are making changes, ranging from posting placards with inspection grades
to including food safety experts on inspection teams.
In
Colorado, health officials were alarmed by their 2016 study showing that long-term care
homes in the state had higher rates of food safety violations than restaurants
and other retail food establishments — sometimes up to 30 times higher.
The
study noted that nurses leading the survey teams tended to call out violations
that were highly visible — missing hairnets, for instance, or chips in the tile
— but less vital to residents’ safety.
The
study found that a trained food safety specialist was more likely to zero in on
critical practices, such as hand-washing, heating and cooling of food, and
handling of raw meat. Last year, the state received grant money to hire a
dedicated food safety expert to begin kitchen inspections in all 270 assisted
living kitchens with 20 or more residents.
Similarly,
Michigan is tapping food safety specialists, such as sanitarians, to help
evaluate nursing home kitchens, even though the federal government only
requires that inspection teams include a registered nurse.
Last
year, Michigan levied the highest number of fines for federal food safety
violations of any state, and collected the most money, more than $3 million,
data show.
States
also have shut down nursing home food operations because of safety problems. In
California, at least three nursing homes had their kitchens temporarily closed
last year because of unsafe conditions. The homes were forced to bring in
restaurant food for residents, or cut a deal with nearby establishments to
supply meals.
Two of
the homes in Southern California had cockroach infestations, while inspectors
at a third facility in the San Francisco Bay Area discovered numerous dead
flies and the “strong smell of feces and sewage” inside the kitchen.
“If you
were to go take those exact same problems and stick them in a Taco Bell or a
Bob Evans, you would never eat there again,” said Lee, of Families for Better
Care.
“There
would be such a public outcry to get those restaurants closed. And they would
be closed, because nobody would go there again.”
Marjie
Lundstrom, FairWarning
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